Why we should be avoiding periorificial mimetic muscles when injecting tissue fillers

Abstract

Background Tissue fillers are generally safe and well tolerated by patients. However, complications do occur and may be very severe, such as intravascular injection (with occasional residual tissue loss, visual and neurological sequelae) and late nodularity and swelling. Methods to lessen the likelihood of complications have been the subject of much recent literature. Depth of injection has been identified as a key safety consideration. Patients/Methods The role of injection of facial filler into the muscular layer of the face is explored in this article. Literature was explored using available search facilities to study the role of injections in or around this layer in the production of significant adverse reactions. Results A body of literature seems to suggest that injection into mimetic musculature of the face especially the musculature in the periorbital and perioral regions is prone to adverse reactions. Conclusions Injection of agents into the perioral and periorbital mimetic muscular layer may produce, product clumping, displacement, and tendency to late nodularity and swelling. It also risks intravascular injection as compared to injection of other layers of the face. Injection into the mimetic muscles especially the sphincteric muscles should be avoided to minimize the risk of complications.

Aspiration Before Tissue Filler—An Exercise in Futility and Unsafe Practice

“…In cadaver studies, vertical needle placement has been shown to allow filler in many layers, 17 including the dangerous muscular lamella. 23 This may be due to the bevel length, which reaches up to 2 mm for a 25-gauge needle (down to 1 mm for 30 gauge). This may allow filler to be deposited not only at the tip but also along the entire length of the bevel and with retrograde flow up the track left by the passage of the needle.…”

“…Currently, deep injections on bone are considered safer practice in the mid-face, deep pyriform space, and temple because deep injections bypass the middle lamella where mimetic or masticatory muscles and major vessels are found. 23 However, foramina are found in the supraperiosteal plane in the mid-face. Cadaver studies have highlighted the relevance of these issues.…”

Treating Aging Changes of Facial Anatomical Layers with Hyaluronic Acid Fillers

“…Injection in the mimetic muscles, especially the sphincteric muscles, should be avoided to minimize the risk of complications. 66 …”

Vascular anatomy of temporal fossa

“…4 There is also an inherent risk of injury or paralysis to the frontal branches of the facial nerve when injecting into this region, which may lead to temporary brow ptosis. Goodman et al 174 recommend avoiding injecting into mimetic muscular layers, as this may produce product clumping, displacement, and tendency for late nodularity swelling. 174 A safe injection zone has been previously outlined by Tansatit et al 38 as the intersection of the temporal and the frontal processes of the zygomatic bone at the posterior angle of the zygoma.…”

“…Goodman et al 174 recommend avoiding injecting into mimetic muscular layers, as this may produce product clumping, displacement, and tendency for late nodularity swelling. 174 A safe injection zone has been previously outlined by Tansatit et al 38 as the intersection of the temporal and the frontal processes of the zygomatic bone at the posterior angle of the zygoma. The maximum depression of the temporal region that is undergoing correction typically resides in this area, allowing it to serve as a landmark for safe injection.…”